All the evidence points to approximately 65% of patients being non-adherent to some degree.
In musculoskeletal (MSK) healthcare, adherence refers to how consistently a patient follows their prescribed treatment plan, such as daily exercises at home.
A study by the Physiotherapy Research Unit at Oxford University Hospitals identifies time pressures on modern life as being the chief culprit resulting in an inability to fit exercises into a daily routine. Other research points to a lack of support from therapists and the mistaken belief of many MSK sufferers that rest is better than movement, particularly when there’s pain involved.
Non-adherence is a big problem: reduced mobility, increased stiffness, and slower recovery taking people away from work and hobbies. And, because MSK conditions are the biggest cost centre in medical claims, when adherence drops… cost rises.
A systematic review of 79 studies showed that non-adherence increases healthcare costs anywhere from £4,000 to £40,000 per patient per year. In older adults, non-adherence isn’t just expensive – it’s deadly – being associated with higher hospitalisation and mortality.
Despite this, non-adherence has remained a bit of an enigma because research has been largely based on unreliable self-reporting. Inaccurate recall and a bias toward an over estimation of doing home-based activities doesn’t help. Apparently middle-aged, highly educated women are the least adherent to physiotherapy home exercise programmes… or are they just more honest?!
Deliberate adherence misreporting is an unknown quantity that leads to unnecessary interventions like additional in-person appointments, scans or even surgery. When patients adhered to early physiotherapy treatment for lower back pain in another study, it reduced the total health cost by 60% over two years. Less imaging, less surgery, less opioid use.
At DocHQ, we apply that same ‘design for adherence’ principle to MSK recovery.
- Firstly the initial consultation – or triage – is arranged ASAP. There is no queue with DocHQ.
- Secondly the platform connects people with their physios in a way that fosters ongoing positive feedback and frequent monitoring of exercise performance. This may be supported by advanced technology but there’s always a ‘human in the loop’.
- Our physio AI, for example, gives patients real-time computer vision feedback and behavioural nudges but all the time is processing data that provides our medical experts with clinical oversight to manage the patient pathway. It’s like having a physio in the room with you. We don’t just know if someone has done their exercises but how well, how consistently and even in how much discomfort those exercises have been performed.
- Most patients begin with 40 to 60 percent movement accuracy and, over time, they improve to 70 to 85 percent, and that’s when outcomes start to shift and it works: the results are pushing adherence to 90% with recovery times dramatically reduced. In fact, because the two are inextricably linked, we have put adherence next to cost on our dashboard. When adherence increases, we see cost reduce proportionately.
Ultimately we can’t do your exercises for you but we can make doing them a lot easier.
Here’s what the platform users are saying:
Denise (rotator cuff tear in shoulder): “My daily log in and pre-set exercises were monitored and performance rated for the physio’s assessment. I think it is a genius way of making sure you are not wasting the physios time by not committing to the programme. My exercises were adapted to suit my needs which can all be done through the contact point all linked in to the email.”
Dorry (repetitive strain injury to neck): “It’s just a case of clicking start workout and it’s all there. It’s so easy to use. I don’t think I would have ever got to see a physio daily. In fact I’ve only been back to see the physio once since I started the whole thing. But she’s there, you know. I’ll email and she’ll reply almost straight away. So she’s very good, very responsive. She was very encouraging in her emails and she was saying you’re really improving, you’re doing well. So I knew she was watching me, keeping an eye on me.”
Learn more about how our platform helps businesses: https://dochq.co.uk/business/physio
Watch our CEO bring more thought provoking issues to the forefront in our series: The Human Side of Healthtech
